Economic Survey: Pakistanis Consuming More Calories, Fruits and Vegetables

[Riaz Haq]

Pakistanis are eating more and healthier foods, according to the Economic Survey of Pakistan 2021-22. Per capita average daily calorie intake in Pakistan has jumped to 2,735 calories in FY 2021-22 from 2,457 calories in 2019-20. The biggest contributor to it is the per capita consumption of fresh fruits and vegetables which soared from 53.6 Kg to 68.3 Kg, less than half of the 144 Kg (400 grams/day) recommended by the World Health Organization. Healthy food helps cut disease burdens and reduces demand on the healthcare system. Under former Prime Minister Imran Khan's leadership, Pakistan succeeded in achieving these nutritional improvements in spite of surging global food prices amid the Covid19 pandemic. 

Pakistan Per Capita Daily Calorie Consumption. Source: Economic Surveys of Pakistan

The trend of higher per capita daily calorie consumption has continued since the 1950s. It has risen from about 2,078 in 1949-50 to 2,400 in 2001-02 and 2735 in 2021-22. The per capita per day protein intake in grams increased from 63 to 67 to about 75 during these years. Health experts recommend that women consume at least 1,200 calories a day, and men consume at least 1,500 calories a day, says Harvard Health Publishing.  The global average has increased from 2360 kcal/person/day in the mid-1960s to 2900 kcal/person/day currently, according to the Food and Agricultural Organization (FAO). The USDA (United States Department of Agriculture) estimates that most women need 1,600 to 2,400 calories, while the majority of men need 2,000 to 3,000 calories each day to maintain a healthy weight. Global Hunger Index defines food deprivation, or undernourishment, as consumption of fewer than 1,800 calories per day.

Share of Overweight or Obese Adults. Source: Our World in Data

The share of overweight or obese adults in Pakistan's population is estimated by the World Health Organization at 28.4%. It is 20% in Bangladesh, 19.7% in India, 32.3% in China, 61.6% in Iran and 68% in the United States.   

Major Food Items Consumed in Pakistan. Source: Economic Survey of P...

The latest edition of the Economic Survey of Pakistan estimates that per capita calories come from the annual per capita consumption of  164.7 Kg of cereals, 7.3 Kg of pulses (daal), 28.3 Kg of sugar, 168.8 liters of milk, 22.5 Kg of meat, 2.9 Kg of fish, 8.1 dozen eggs, 14.5 Kg of ghee (cooking oil) and 68.3 Kg of fruits and vegetables.  Pakistan's economy grew 5.97% and agriculture outputs increased a record 4.4% in FY 2021-22, according to the Economic Survey. The 4.4% growth in agriculture has boosted consumption and supported Pakistan's rural economy.  

Pakistan Growth Indicators. Source: Economic Survey 2021-22

The minimum recommended food basket in Pakistan is made up of basic food items (cereals, pulses, fruits, vegetables, meat, milk, edible oils and sugar) to provide 2150 kcal and 60gram protein/day per capita. 

The state of Pakistan's social sector is not as dire as the headlines suggest. There are good reasons for optimism. Key indicators show that nutrition and health in Pakistan are improving but such improvements need to be accelerated. 

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[Riaz Haq]

India Hunger Index Controversy:

Noted columnists in India have also commented on how a faulty metric, which is based on four measures or indicators (none of which actually measure hunger) is creating a flawed narrative against India9,10. Prominent researchers have commented that the GHI exaggerates the measure of hunger, lacks statistical vigour10, has a problem of multiple counts11,12, and gives higher representation to under-five children. The measurement of hunger is complex and should not be oversimplified, as in the GHI13. Therefore, the use of alternative approaches should be considered to evaluate hunger14,15. In view of these issues, the Indian Council of Medical Research (ICMR), Department of Health Research of the Ministry of Health and Family Welfare, Government of India, constituted in 2019 an Expert Committee to review the indicators used in the GHI. The deliberations of this Committee are presented here, and it is argued that the four indicators used in the GHI, [undernourishment, stunting, wasting and child mortality (CM)] do not measure hunger per se, as these are not the manifestations of hunger alone.

Go to:
About the GHI
The GHI is a weighted average derived from four indicators1. These are (i) the PUN, or proportion of the population that is undernourished, calculated as the proportion of the population that has an energy intake less than the FAO Minimum Dietary Energy Requirement (MDER) of 1800 calories/capita/day1; (ii) CWA, or the prevalence of wasting in children under five years old, estimated as the percentage of children aged 0-59 months, whose weight for height is below minus two standard deviations (-2SD) from the median of the WHO Child Growth Standards1; (iii) CST, or the prevalence of stunting in children under five years old, estimated as the percentage of children, aged 0-59 months, whose height for age is below -2SD from the median of the WHO Child Growth Standards; and (iv) CM, or the proportion of children dying before the age of five, estimated as the proportion of child deaths between birth and five years of age, generally expressed per 1000 live births. As per the justification mentioned in the GHI report1 for using these indicators, the PUN indicator captures the nutrition situation of the entire population while the other indicators are specific to under-five children (CWA, CST and CM) in which the adverse effects assume greater importance. The inclusion of both wasting and stunting (CWA and CST) is intended to allow the GHI to consider both acute and chronic undernutrition.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9131786/

[Riaz Haq]

‘Diet of Average Indian Lacks Protein, Fruit, Vegetables’
On average, the Indian total calorie intake is approximately 2,200 kcals per person per day, 12 per cent lower than the EAT-Lancet reference diet's recommended level.

https://www.india.com/lifestyle/diet-of-average-indian-lacks-protei...

Compared to an influential diet for promoting human and planetary health, the diets of average Indians are considered unhealthy comprising excess consumption of cereals, but not enough consumption of proteins, fruits and vegetables, said a new study.Also Read - Autistic Pride Day 2020: Diet Rules For Kids With Autism

The findings by the International Food Policy Research Institute (IFPRI) and CGIAR research program on Agriculture for Nutrition and Health (A4NH) broadly apply across all states and income levels, underlining the challenges many Indians face in obtaining healthy diets.

“The EAT-Lancet diet is not a silver bullet for the myriad nutrition and environmental challenges food systems currently present, but it does provide a useful guide for evaluating how healthy and sustainable Indian diets are,” said the lead author of the research article, A4NH Program Manager Manika Sharma. Also Read - Experiencing Hair Fall? Include These Super-foods in Your Daily Diet ASAP

“At least on the nutrition front we find Indian diets to be well below optimal.”

The EAT-Lancet reference diet, published by the EAT-Lancet Commission on Food, Planet, and Health, implies that transforming eating habits, improving food production and reducing food wastage is critical to feed a future population of 10 billion a healthy diet within planetary boundaries.

While the EAT-Lancet reference diet recommends eating large shares of plant-based foods and little to no processed meat and starchy vegetables, the research demonstrates that incomes and preferences in India are driving drastically different patterns of consumption.

[Riaz Haq]

#Modi says bhajans (#Hindu religious songs) will cure #malnutrition. Over 35% of #Indian children are stunted, 19.3% wasted & 32.5% underweight.
BJP rule has seen undernourished population increase from 14.9% to 15.5% of population https://science.thewire.in/health/narendra-modi-malnutrition-bhajan/ via @TheWireScience


In the 92nd episode of ‘Mann ki Baat’, Prime Minister Narendra Modi said conducting bhajans can be part of the solutions to reducing malnutrition.
Cultural and traditional practices are not harmful. But it is in bad faith to make them part of habits that sideline tested and approved solutions to crucial welfare issues.
The statement also distracts from the fact that in Modi’s time as prime minister, India has come to account for a quarter of all undernourished people worldwide

There is much evidence in the public domain that says the availability, accessibility and affordability of good-quality food is crucial to improve the nutritional and health status of India’s people. There is nothing, however, about bhajans.

Many scholars and scientists have often criticised Prime Minister Modi for his irrational claims on many occasions. Reminiscent of his “taali, thali and Diwali” campaign as the COVID-19 pandemic was gaining strength, Modi’s comment on bhajans only distracts from the dire importance of effective public health measures – even as the rate of improvement of some important indicators have slid in his time at the helm.

Cultural and traditional practices are not harmful. But it is in bad faith to make them part of habits that sideline tested and approved solutions to crucial welfare issues.

In his monologue, Modi narrated a story of how people of a community in Madhya Pradesh each contribute a small quantity of grains, using which a meal is prepared for everyone one day a week. However, he shifted the focus at this point to devotional music in bhajan–kirtans – organised under the ‘Mera Bachha’ campaign – instead of dwelling on the role of Indigenous food cultures. This is counterproductive.

More malnourished children

India’s National Family Health Surveys (NFHS) and Comprehensive National Nutrition Surveys have documented the high prevalence of malnutrition and micronutrient deficiency among India’s children, adolescents and women. The recently published NFHS-5 results reported a high prevalence of stunting, wasting and underweightedness among children younger than five years and that they have declined only marginally in the last five years.

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A public-health approach to malnutrition requires us to pay attention to a large variety of socioeconomic conditions. In this regard, while many of Prime Minister Modi’s other comments in his monologue are well-taken, especially about public participation, neither the need for context-specific interventions nor for evidence-based policies are served by misplaced allusions to bhajans and kirtans.

[Riaz Haq]

Why Is Urban India Hungry For Nutrition

http://bwhealthcareworld.businessworld.in/article/Why-Is-Urban-Indi...

More than two billion people globally suffer from ‘hidden hunger’, simply put, micronutrient deficiencies. Protein, calcium, iron, zinc and essential vitamins such as Vit D, Vit B12 that the body requires to function

For the longest time, hunger has been associated with the poor. Malnutrition is a term, we are all used to by now, especially in developing nations. However, the sound of ‘urban hunger’ may ring an unfamiliar bell in most ears. The urbanites or city dwellers are known for access and affordability yet there is a growing hunger for nutrition being cited in research today.

As per the comprehensive National Nutrition survey (CNNS 2016-2018) conducted by the Ministry of Health and Family Welfare, the percentage of the population with iron deficiency has been reported to be highest at 27 per cent in the richest sector for both 5-9 and 10-19 years of Indian children and adolescents. Same is the case with Folate, Vit D, Vit B12, and Zinc deficiency.

More than two billion people globally suffer from ‘hidden hunger’, simply put, micronutrient deficiencies. Protein, calcium, iron, zinc and essential vitamins such as Vit D, Vit B12 that the body requires to function. To put it in a closer-home perspective, it could be 7 out of 10 Indians. India has recorded a triple burden of malnutrition with 189 million suffering from undernutrition, 135 million impacted by over nutrition and a whopping 700 million lacking some form of micronutrient deficiency.

Despite being highlighted as one the most cost-effective investments for human development, progress on addressing micronutrient deficiencies or mind has not shown an upward trend in recent years.

Hidden hunger does not allow children to reach their growth potential. 22 per cent of children and adolescents remain affected by stunting or low height for age and 24 per cent by wasting or low weight for height. The key micronutrient gap is not only a problem of the poor but also a big problem for middle and rich households; the problem deteriorates as kids grow older. This is also one of the reasons for instances of non-communicable diseases (NCDs) like diabetes, cardiovascular diseases, and hypertension is on the rise among adolescents.

India is a predominantly cereal-consuming nation and lacks a balanced diet. Keep in mind that Indian meals are big but not balanced, with big gaps in nutrient density. Fussy eating in younger children and unhealthy eating habits in older children are fueling gaps in nutrient intake, leading to poor nutritional status and early onset of NCDs.

Some more facts or key nutrition concerns cited by national data sets:

5 vital micronutrient deficiencies reported in both urban and rural children between 1-

19 years

One in 2 adolescents suffer from at least 2/5 micronutrient deficiencies – (Iron,

Folate, B12, Vitamin D, Vitamin A and Zinc)

Protein intake, especially in terms of quality, is still a big concern. Diets are

predominantly carbohydrate centric and lack diversity from dairy, pulses etc.

Bioavailability especially of minerals like iron, zinc is poor from a plant-based diet

Consumption of animal-based foods- milk, meat, eggs still low in the country leading

to poor nutritional status in nutrients like protein, iron, zinc, vitamin B12 etc.

Also, there is increased consumption of salt and sugar in the country along with junk foods or packaged foods, or outside food. Data shows increased consumption of 119 per cent more salt than the WHO recommendation and 180 per cent more sugar than the prescribed limit. The world of nutrition is still greek to Indian consumers which hinders their purchase choices.

The impact of this unsolved burden of malnutrition is huge. It leads to loss of productivity, illness, and increased healthcare costs, even may prove to be fatal with a loss of a minimum of 1 per cent of India’s GDP, approximately Rs.160K cr.

[Riaz Haq]

Food Sources
Meats, poultry, and seafood are richest in heme iron. Fortified grains, nuts, seeds, legumes, and vegetables contain non-heme iron. In the U.S. many breads, cereals, and infant formulas are fortified with iron.

https://www.hsph.harvard.edu/nutritionsource/iron/#:~:text=Food%20S....


Iron is an important mineral that helps maintain healthy blood. A lack of iron is called iron-deficiency anemia, which affects about 4-5 million Americans yearly. [1] It is the most common nutritional deficiency worldwide, causing extreme fatigue and lightheadedness. It affects all ages, with children, women who are pregnant or menstruating, and people receiving kidney dialysis among those at highest risk for this condition.

Iron is a major component of hemoglobin, a type of protein in red blood cells that carries oxygen from your lungs to all parts of the body. Without enough iron, there aren’t enough red blood cells to transport oxygen, which leads to fatigue. Iron is also part of myoglobin, a protein that carries and stores oxygen specifically in muscle tissues. Iron is important for healthy brain development and growth in children, and for the normal production and function of various cells and hormones.

Iron from food comes in two forms: heme and non-heme. Heme is found only in animal flesh like meat, poultry, and seafood. Non-heme iron is found in plant foods like whole grains, nuts, seeds, legumes, and leafy greens. Non-heme iron is also found in animal flesh (as animals consume plant foods with non-heme iron) and fortified foods.

Iron is stored in the body as ferritin (in the liver, spleen, muscle tissue, and bone marrow) and is delivered throughout the body by transferrin (a protein in blood that binds to iron). A doctor may sometimes check blood levels of these two components if anemia is suspected.

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Sources of heme iron:
Oysters, clams, mussels
Beef or chicken liver
Organ meats
Canned sardines
Beef
Poultry
Canned light tuna
Sources of non-heme iron:
Fortified breakfast cereals
Beans
Dark chocolate (at least 45%)
Lentils
Spinach
Potato with skin
Nuts, seeds
Enriched rice or bread

[Riaz Haq]

In the 2022 Global Hunger Index, Pakistan ranks 99th out of the 121 countries with sufficient data to calculate 2022 GHI scores. With a score of 26.1, Pakistan has a level of hunger that is serious.

https://www.globalhungerindex.org/pakistan.html

In the 2022 Global Hunger Index, India ranks 107th out of the 121 countries with sufficient data to calculate 2022 GHI scores. With a score of 29.1, India has a level of hunger that is serious.

https://www.globalhungerindex.org/india.html

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India also ranks below Sri Lanka (64), Nepal (81), Bangladesh (84), and Pakistan (99). Afghanistan (109) is the only country in South Asia that performs worse than India on the index.


https://www.thehindu.com/news/national/india-ranks-107-out-of-121-c...


India ranks 107th among 121 countries on the Global Hunger Index, in which it fares worse than all countries in South Asia barring war-torn Afghanistan.

The Global Hunger Index (GHI) is a tool for comprehensively measuring and tracking hunger at global, regional, and national levels. GHI scores are based on the values of four component indicators — undernourishment, child stunting, child wasting and child mortality. Countries are divided into five categories of hunger on the basis of their score, which are ‘low’, ‘moderate’, ‘serious’, ‘alarming’ and ‘extremely alarming’.



Based on the values of the four indicators, a GHI score is calculated on a 100-point scale reflecting the severity of hunger, where zero is the best score (no hunger) and 100 is the worst.

India’s score of 29.1 places it in the ‘serious’ category. India also ranks below Sri Lanka (64), Nepal (81), Bangladesh (84), and Pakistan (99). Afghanistan (109) is the only country in South Asia that performs worse than India on the index.



Seventeen countries, including China, are collectively ranked between 1 and 17 for having a score of less than five.

India’s child wasting rate (low weight for height), at 19.3%, is worse than the levels recorded in 2014 (15.1%) and even 2000 (17.15), and is the highest for any country in the world and drives up the region’s average owing to India’s large population.

Prevalence of undernourishment, which is a measure of the proportion of the population facing chronic deficiency of dietary energy intake, has also risen in the country from 14.6% in 2018-2020 to 16.3% in 2019-2021. This translates into 224.3 million people in India considered undernourished.

But India has shown improvement in child stunting, which has declined from 38.7% to 35.5% between 2014 and 2022, as well as child mortality which has also dropped from 4.6% to 3.3% in the same comparative period. On the whole, India has shown a slight worsening with its GHI score increasing from 28.2 in 2014 to 29.1 in 2022. Though the GHI is an annual report, the rankings are not comparable across different years. The GHI score for 2022 can only be compared with scores for 2000, 2007 and 2014..



Globally, progress against hunger has largely stagnated in recent years. The 2022 GHI score for the world is considered “moderate”, but at 18.2 in 2022 is only a slight improvement from 19.1 in 2014. This is due to overlapping crises such as conflict, climate change, the economic fallout of the COVID-19 pandemic as well as the Ukraine war, which has increased global food, fuel and fertiliser prices and is expected to "worsen hunger in 2023 and beyond."



The prevalence of undernourishment, one of the four indicators, shows that the share of people who lack regular access to sufficient calories is increasing and that 828 million people were undernourished globally in 2021.

There are 44 countries that currently have “serious” or “alarming” hunger levels and “without a major shift, neither the world as a whole nor approximately 46 countries are projected to achieve even low hunger as measured by the GHI by 2030,” notes the report.

[Riaz Haq]

Pakistan is the world’s 6th largest sugar producing country

Pakistan produces 6.1 million tons of sugar in 2022

https://worldpopulationreview.com/country-rankings/sugar-producing-...


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Pakistan 5th largest sugar cane producing country


67 million tons of sugar cane in 2019

https://www.nationmaster.com/nmx/ranking/sugar-cane-production

[Riaz Haq]

How India can boost millets cultivation
A region-specific strategy and their introduction in mid-day meals in schools and anganwadis could boost millets cultivation. The need for wholesome nutrition would also be more for children in the very regions that are suited for millet cultivation

https://indianexpress.com/article/opinion/editorials/mid-day-meals-...


The United Nations has, at India’s initiative, declared 2023 as the International Year of Millets. This, even as India’s own production of these “nutri cereals” — jowar, bajra and ragi and minor millets such as kodo, kutki, kakun, sanwa, cheena and kuttu — has fallen from 23-24 million to 19-20 million tonnes over the last 4-5 decades. The reason: Millets aren’t the first choice either of consumers or producers. Kneading dough and rolling rotis is much easier with wheat than with millet flour. Wheat has gluten proteins that make the dough more cohesive and elastic. The resultant breads come out soft, unlike with millets that are gluten-free. The public distribution system (PDS) has made rice and wheat accessible even to the rural poor, for whom these were previous aspirational cereals. For farmers, too, millets are orphan crops. With access to irrigation, they will immediately switch to growing wheat and rice that yield 3-4 times more than jowar or bajra.

That said, cultivation of millets deserves a special push, given their nutritional superiority over wheat and rice — whether in terms of amino acid profile or vitamins, minerals and crude fibre content. They are also hardier and drought-resistant crops, which has to do with their short growing season (70-100 days, as against 120-150 days for paddy and wheat) and lower water requirement (350-500 mm versus 600-1,200 mm). The right strategy would be to promote their cultivation in those regions — rain-fed semi-arid and hilly terrains — where they have been well-adapted. One cannot expect farmers in Punjab or coastal Andhra Pradesh to grow bajra and ragi; the yield sacrifices and opportunity costs of diverting irrigated land for these would be far too high. A more realistic approach is to incentivise farmers in western Rajasthan, southern Karnataka or eastern Madhya Pradesh — who are already cultivating bajra, ragi and minor millets — to not shift to rice and wheat. These districts/regions can, in turn, be developed as clusters for particular millets — like Dindori in MP for kodo and kutki.

The same region-specific strategy could be adopted even for boosting consumption. India, according to data for 2021-22, has 14.89 lakh schools with 26.52 crore students. These, plus another 14 lakh pre-school anganwadi centres, constitute a large potential market for millets. The PDS can continue supplying rice and wheat, which are more amenable to nationwide procurement, stocking and distribution. But the schools and anganwadis can serve khichdi, dosas, energy bars and puddings made from locally-sourced millets, along with a daily glass of milk and egg for every child. The need for such wholesome nutrition would be more for children in the very regions that are suited for millet cultivation.

[Riaz Haq]

Flour crisis deepens in Pakistan | World Grain

https://www.world-grain.com/articles/18326-flour-crisis-deepens-in-...

ISLAMABAD, PAKISTAN — Despite slight increases expected for wheat production and imports in Pakistan, consumption is forecast to outstrip supply in marketing year 2023-24 in the country with the world’s fifth largest population, according to a Global Agricultural Information Network report from the Foreign Agricultural Service of the US Department of Agriculture (USDA).

Although a slight reduction in planted area is anticipated, wheat production in Pakistan is projected to increase 2% to 27 million tonnes, with wheat yield expected to rise due to favorable weather conditions and better availability of irrigation water. However, wheat consumption is forecast to increase 3% in 2023-24, the USDA said, in one of the fastest growing countries in the world with a population of 233 million. The shortage of wheat, which accounts for 72% of Pakistan’s daily caloric intake, has caused a flour-availability and affordability crisis in Pakistan.

“High inflation has made it difficult for consumers to afford milk and meat, reversing the trend of more protein and less carbohydrates in the diet,” the USDA said. “As a result, consumption of wheat flour-based products is rebounding.”

But the supply is not rebounding at the same rate, in part due to the weather, the Russia-Ukraine war and other factors, causing many of the country’s citizens to wait in long lines in hopes of getting a bag of government-subsidized flour. Dozens of people have been trampled to death or injured in recent weeks when crowds have rushed forward to try to get the flour.

According to a recent World Food Programme report, the prices for staple cereals, pulses, and non-cereal food commodities continue to increase in Pakistan. It noted that the price of wheat flour has increased by 74% year-on-year.

“The price of wheat and wheat flour has continued to increase in the country due to various factors, including the tight supply of private wheat, hoarding and profiteering,” the WFP report said.

[Riaz Haq]

Assessment of macronutrients consumption in the diet of adolescent school children in four seasons: A longitudinal study from an urban city in Pakistan

https://ecommons.aku.edu/cgi/viewcontent.cgi?article=1230&conte...

Abstract Background: A healthy diet in the adolescence period is essential for physical, mental, and immunological development. We aimed to assess macronutrient consumption in the diet of adolescent school children using 24 h recalls in four seasons of the year. Method: This was a longitudinal study conducted from February 2014 to June 2015. The study population included 155 school children aged 7–14 years from an urban school in Karachi. 24HR recall was conducted on 4 random days of the 4 main seasons. A food composition table was developed where the weight, calories, carbohydrate, fat, and protein content of the food items were listed. Macronutrients quantifcation was calculated by using proportional weight from the food composition table. Food groups were also assigned to each food item including vegetables, fruits, grains, protein foods, dairy products, and oils. Results: A total of 155 adolescent children aged between 7 and 14 years were approached. Out of the 155 preadolescents and adolescents, 150 (96.7%) agreed to participate. The mean (SD) age of the children was 11.31 (1.6) years, and 59% of all the children were males. Overall mean (SD) daily intake for all seasons was 195.31 (86.87) grams of carbohydrates, 94.77 (71.87) grams of proteins, and 55.87 (30.79) grams of fats. Carbohydrates formed 48.16%, protein 21.92%, and fat 29.93% of the total caloric intake. The mean (SD) daily caloric intake was 1517 (644) grams. Overall, the highest source of calories was from carbohydrate 781 (347) Kilocalories (Kcal), followed by fat 502 (277) Kcal and protein 379 (287). The Carbohydrate intake in 24 h was highest in the autumn; 212.81 (85.37), and there was a signifcant diference in carbohydrate intake in all seasons (p value 0.003). Consumption of discretionary food group was high (31.3%), and consumption of fruits and vegetables was low (29%). Conclusion: The study reports a suboptimal caloric intake of fewer than 2000 cal/day among the adolescents from school. The highest source of calories was from carbohydrates.The highest consumption of food was in autumn and the least in summer. Fruits and vegetable intake was low, and discretionary food intake was high.